If your doctor expects you to be unable to ever work again in your occupation or business due to an illness or an injury, then notify us as soon as practicable.
In order to qualify for a total and permanent disability benefit under your policy, you must be totally incapacitated by illness or injury, and as a result of that incapacity:
Your policy also provides a partial and permanent disability benefit which is payable in the event that you permanently lose the use of a limb or the sight of an eye due to an illness or an injury. The benefit amount is the lesser of $25,000 and 25% of your cover for total and permanent disability. Check your policy for details.
After Sovereign has been notified of your intention to make a claim, a case manager will be assigned to your claim, and in the first instance will phone you for a discussion about your condition. If the nature and extent of your condition might be covered by the policy then the case manager will send a letter to you which details the information needed to assess your claim. The information required includes the following:
It would also assist if you provided copies of any relevant documents or reports from your doctor or specialist.
Following receipt and assessment of the above information, further medical information will be requested by the case manager for the claim to proceed. This will include an assessment by an occupational medicine specialist who will consider your job description and the medical information supplied, and provide an opinion on your ability or otherwise to resume your occupation or business.
Following receipt of all required information, the claim is then assessed. On acceptance of the claim, a Claim Discharge Form is prepared and sent to you. The claim is paid after receipt of the signed Discharge Form, with the amount being direct-credited to the bank account you nominate on the form.
The entire claims process can be illustrated as follows: